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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101270
Report Date: 09/30/2022
Date Signed: 09/30/2022 12:29:56 PM

Document Has Been Signed on 09/30/2022 12:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SHABNAM, FNU FAMILY CHILD CAREFACILITY NUMBER:
376101270
ADMINISTRATOR:FNU SHABNAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 951-4149
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
09/30/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Fnu Shabnam and Khwaja Ghafoo SidiqiTIME COMPLETED:
12:35 PM
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On 09/30/2022 at 10:50am, Licensing Program Analyst (LPA) Selina Siao conducted an announced change of location Pre-Licensing inspection with the applicant Fnu Shabnam (primary language is Farsi and Dari), her husband Khwaja Ghafoo Sidiqi and their son. The 3 bedroom, 2 bath house was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fire extinguisher size 3A10BC, smoke and carbon monoxide detector are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water at home and applicant stated that the home does not have any weapon. Applicant's EMSA approved CPR and First Aid cards are current due to expire on 08/2024 and she completed the 8 hours preventative health practice course on 02/2018 and the Lead Poisoning Prevention course on 12/2020. A review of staff records on this date indicates that applicant and her husband are the current adults that lives at the home and has the required background clearances and the required immunizations. Applicant and her husband are owners of property and they have provided proof of ownership.

Applicant will be using the following areas for childcare: front living room, upper level living room, dining room and kitchen and main bathroom. The fire place located in the front living room and dining room has a fire place that is blocked off with a screen. The upper level living room has a sliding door that is latched at the top to prevent the door from opening more than 4 inches. Off limit areas includes: garage, master bedroom and bathroom, bedroom #2, bedroom #3 and the balcony that is located outside of the upper living room. . The home has some toys and equipment available for children. The home has a fenced backyard available for children to play and visual supervision is needed when the children are playing outside to ensure children's safety.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SHABNAM, FNU FAMILY CHILD CARE
FACILITY NUMBER: 376101270
VISIT DATE: 09/30/2022
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LPA reviewed the children's records, facility roster and all the records are in ordered. Applicant was also reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.

Application was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

The home has a fire clearance for a large license on 09/19/2022. The following correction is needed prior to granting a license:
  • Place a safety gate at the bottom of the stairs
  • The shed door located in the backyard needs to be secure to ensure children cannot enter the area.
  • Require postings needs to be posted at the home
Applicant shall submit pictures of the above corrections to LPA within 10 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
LIC809 (FAS) - (06/04)
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